Dementias: Common causes and Their Treatments

1. Dementias: Common causes and Their Treatments Presented by:Mehran Homam Department of Neurology Azad university

2. Dementia Progressive deterioration of intellect, behavior and personality as a consequence of diffuse disease of the brain hemispheres, maximally affecting the cerebral cortex and hippocampus. Dementia is a symptom of disease rather than a single disease entity!!!

3. Dementias – causes • 1-Alzheimer‘s disease(~60% of all dementias) • 2-Cerebrovascular(multiinfarct state, subcortical small vessel, amyloid angiopathy,…) (~20%) • 3-Neurodegenerative(DLB, Pick‘s disease, Huntington‘s chorea, Parkinson‘s disease) • 4-Infectious(Creutzfeld-Jakob disease, HIV infection, progressive multifocal leucoencephalopathy) • 5-Normal pressure hydrocephalusTREATABLE! • 6-Nutritional(thiamine deficiency in alcoholics!, B12 deficiency, folate deficiency) • 7-Metabolic(hepatic disease, thyroid d., parathyroid d., Cushing‘s syndrome) • 8-Chronic inflammatory(MS, …) • 9-Trauma(head injury, ’Punch drunk‘ syndrome) • 10-Tumor (e.g. subfrontal meningioma)

5. 1-Alzheimer’s Disease • -60-80% of cases of dementia in older patients • -Memory loss, personality changes, global cognitive dysfunction and functional impairments • -Apraxia • -Language disturbances • -Personality changes • -Visual spatial disturbances (early finding) • Delusions/hallucinations (usually later in course)

7. 1-Alzhimers Disease:treatment • 1-Ach E Inhibitors:Exelon/Aricept/galantamine • 2-Memantine: NMDA antagonist • 3-Vit E • 4-Ginko • 5-nsaids • 6-Ssris • 7-antipsychotics:Quetiapen/olanzaine/rispiridone • 8-gene therapy & monoclonal antibodies • the most important:support of patient & family

8. 2-vascular Dementia • -its present in many cases of Alzhimers disease • -25 to 30% of patients admitted for acute strokes were found to demented 3 months after event • -it should be differentiated from abulia or aphasic syndromes

9. 2-vascular Dementia;treatment • -Prevention of subsequent vascular events • -Depression is common serteraline is choice • -Tricyclic antidepressents should be avoided • -New researches shows benefical effects of cholinestrae inhibitors • -it seems risk factors of cva are same as alzheimer!

10. Normal pressure hydrocephalus • term applied to the triad of: • Dementia • Gait disturbance • Urinary incontinence • occuring in conjunction with hydrocephalus and normal CSF pressure. • Two types: • NPH with a preceding cause (SAH, meningitis, trauma, radiation-induced). • NPH with no known preceding cause – idiopathic (50%).

11. Normal pressure hydrocephalus-treatment • 1-ethiologic cause if present • 2-drugs which reduce csf production • 3-surgery:shunt • 4-symptomatic treatment.

12. AIDS Dementia complex • -the most common in young adults in western countries • -Approximately two-thirds of persons with AIDS develop dementia, mostly due to AIDS dementia complex. • -In some patients HIV is found in the CNS at postmortem. In others an immune mechanism or an unidentified pathogen is blamed. • -Dementia is initially of a "subcortical " type. • -CT - atrophy; MRI - increased T2 signal from white matter. • -Treatment with Zidovudine (AZT) halts and partially revers neuropsychological deficit.

13. Adults and children living with HIV/AIDS as of end 2009 Eastern Europe & Central Asia 360 000 Western Europe 520 000 North America 920 000 East Asia & Pacific 530 000 North Africa & Middle East 220 000 South & South-East Asia 6 million Caribbean 360 000 Sub-Saharan Africa 23.3 million Latin America 1.3 million Australia & New Zealand 12 000 Total: 73.6 million 99000-E-1 – 1 December 1999

14. Trauma • reduction of intellectual function is common after severe head injury. • Chronic subdural haematoma can also present as progressive dementia, especially in the elderly. • Punch-drunk encephalopathy (dementia pugilistica) is the cumulative result of repeated cerebral trauma. It occurs in both amateur and professional boxers and it manifests by dysarthria, ataxia and expy signs associated with ’subcortical‘ dementia. There is no treatment for this progressive syndrome.

15. Subdural hematoma

16. Tumor • -Dementia rarely may be due to intracranial tumour, especially when tumours occur in certain anatomical sites. • -Mental or behavioral changes occur in 50-70% of all brain tumours as distinct from dementia which is associated with frontal lobe tumours, III ventricle tumours and corpus callosum tumours. • -Cognitive impairment also occurs as a non metastatic complication of systemic malignancy.

17. Treatable causes 0f Dementia • D;Depression • E:Endocrine • M:Metabollic(B12) • E:Encephalitis • N:Neoplasm • T:Trauma • I:Infection • A:Alchol

18. Conclusion • 1-common causes could managed better than previous • 2-causes are different and their prevalence may change in future • 3-mixed types may present • 4-physician should not forget treatable causes